Study of sunbathing in children: the preliminary evaluation of a prevention program.

AIMS AND BACKGROUND: Sunburn during childhood is associated with an increased risk for developing melanoma in an adult age. The aim of the present study was to define the validity of our educational program in order to teach the positive effects and risks of sun exposure during childhood. PATIENTS AND METHODS: We conducted a population-based, case-control study in primary schools of three towns in Northern Italy (Brescia, Bergamo and Trento) between 2001 and 2002. The study was carried out on 1945 pupils (aged 8-9 years) and included 1309 case children who received an educational program before the summer to increase awareness towards sun exposure and 636 control children who did not. Parents of case and control children were interviewed using a questionnaire about their children's skin characteristics, sun protective behavior and sunburns. The questionnaire was completed twice, before and after the summer, to verify the changes of sun exposure habits. RESULTS: A significant decrease in sunburns was demonstrated in the group of subjects who received the educational program, indicating the validity of our operative procedure (from 14.6% to 10%, P = 4 x 10(-4). CONCLUSIONS: Our educational melanoma program may be important to disseminate in a wider range of children a correct education on sun exposure during childhood.

Clinical and dermatoscopic diagnosis of small pigmented skin lesions.

Small pigmented skin lesions represent a new challenge for all physicians devoted to the early diagnosis of melanoma. The purpose of this prospective study was to establish the diagnostic value of the clinical and the dermatoscopic examinations in a population of 157 consecutive patients with 161 small (< or = 6 mm) pigmented lesions, recruited in a short time. Of these 161 lesions, 13 were thin melanomas (median thickness 0.49 mm). In this population, clinical evaluation produced a diagnostic sensitivity of 77% and a specificity of 74%. Dermatoscopy resulted in a sensitivity of 77% and in a specificity of 72%. Combining clinical and dermatoscopic evaluations all the melanomas were preoperatively recognised. The results of the present study stress the complementary role of clinical and dermatoscopic examinations. In particular, clinical evaluation remains of utmost importance in diagnosing melanoma. This concept must be stressed in the education and training of young dermatologists.

Micro-melanoma detection. A clinical study on 22 cases of melanoma with a diameter equal to or less than 3 mm.

BACKGROUND AND AIMS: Very small pigmented lesions may represent an extreme diagnostic challenge to the clinician. Our aim was to describe the clinical and dermoscopic features in a series of cutaneous melanomas with a maximum clinical diameter of 3 mm. METHODS: We conducted a retrospective study of the 924 primary melanomas seen and treated during a period of five years at the Unit for Melanoma Detection of the Istituto Nazionale Tumori of Milan, Italy. The size characteristics of the considered lesions allowed the identification of 22 (2.4%) cases of micro-melanoma (clinical diameter of 3 mm or less). Sixteen of these cases were subjected to dermoscopy. The clinical and dermoscopic features as well as the corresponding diagnoses were recorded. RESULTS: The typical lesion presents as a small, dark, often black macule, generally evenly colored, with well-defined borders; it may be asymmetric or symmetric in shape. These features prompted a correct clinical diagnosis in nearly half of the cases. Dermoscopy lead to a correct diagnosis in all cases subjected to the technique. CONCLUSION: Dermoscopy appears to be an efficient aid to the diagnosis of micro-melanomas, provided that clinicians are aware of this type of lesion and maintain the index of suspicion at a high level.

Narrower surgical margins might be sufficient in invasive horizontal growth phase melanoma.

BACKGROUND AND AIMS: The delineation of horizontal and vertical growth phases in primary cutaneous melanoma has contributed to our understanding of melanoma progression. Horizontal growth phase invasive melanomas are now believed to metastasize very rarely. Consequently, some of us have started to treat these lesions with very limited surgical margins, assuming that in terms of biological behavior this type of melanoma is more similar to an in situ than an invasive lesion. METHODS: Between January 1997 and December 2001 42 lesions of this type in 41 patients (24 women and 17 men) were treated in the outpatient clinic under local anesthesia. The excision margin was half a centimeter and the subcutaneous fat was cleared in most cases to the deep fascia, which was conserved. Loss was made good by direct tissue closure. All patients had undergone an excisional biopsy before definitive surgery. The size of the lesions ranged from 2 mm to 19 mm in maximum linear extent (median 7 mm). Lesion thickness ranged from 0.11 mm to 0.58 mm (median, 0.27 mm). RESULTS: The median follow-up was 47 months (range, 26-83). During this period none of the patients had locoregional or distant relapses. CONCLUSIONS: This preliminary report seems to corroborate the assumption that horizontal growth phase melanoma is not an aggressive lesion and might therefore be cured by non-aggressive surgery. The proper treatment of such lesions might be a surgical excision at half a centimeter distance from the biopsy scar. This approach may produce very good cosmetic results, while keeping the costs and required resources to a minimum.

Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.

OBJECTIVE: To ascertain whether childhood melanoma presents any peculiar clinical features or differences in prognosis with respect to adults, we retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Nazionale Tumori, Milan, over a 25-year period. METHODS: Primary lesions were amelanotic in half of the cases and raised in 73%. Lower extremities were the most common primary sites. Histologically, 9 cases were classified as nodular type, and median thickness was 2.5 mm. Nine children had nodal involvement at diagnosis, 2 in-transit metastases, and 1 distant spread. Surgery was the mainstay of treatment; 9 patients underwent lymph node dissection, 3 received chemotherapy, and 2 received radiotherapy. RESULTS: With a median follow-up of 122 months, 5-year event-free survival and overall survival were 60% and 70%, respectively. Age seemed to correlate with survival, event-free survival being 90% in children under 10 and 47% in older patients, although the initial microstaging seemed worse in the former. CONCLUSION: By comparison with adult cases, childhood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions. Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves differently in the younger age group.